Volume 11 Issue 9, September 2014

Studies suggest that there is a link between obesity and a reduced risk of low-risk cancers, but an increased risk of high-grade, lethal disease. A recent paper has attempted to further define this risk, and causes us to question whether active surveillance is an appropriate treatment option for obese patients.

New AUA guidelines on the management of patients with kidney stones are a welcome addition to a field that, over the past few decades, has been neglected by urologists. Despite some limitations, this document is an extremely important reminder of what we can—and should—offer our stone-forming patients.

A new model that predicts in vitro fertilization outcomes is planned by the Society for Assisted Reproductive Technology based on US data. However, the proposed model ignores important variables and does not address the most important clinical outcome: the birth of a healthy baby to a healthy mother.

Placebo effects are a major factor in randomized control trials of treatments for interstitial cystitis/bladder pain syndrome. Two studies in the past 4 years have shown greater placebo effects than are usually reported in the literature. A recent report by Bosch investigated how these placebo effects are enhanced by education and behavioural modification strategies.

Advances in knowledge, diagnostic procedures and available treatment options enable continual improvements in treatment of urogenital organs after severe trauma. The American Urological Association's first urotrauma guidelines include statements organized in a practical and straightforward manner and classified by the affected urogenital organ, to assist in the treatment of urotrauma.

Premature ejaculation (PE) is a common ailment in men but its pathophysiology remains unclear. Updated guidelines from the International Society of Sexual Medicine attempt to aid the diagnosis and treatment of PE, and here we give our opinion on the best course of action for affected patients.

The multifunctional NUMB protein negatively regulates the NOTCH signalling pathway, which is deregulated in prostate cancer. The authors detail the complex interactions between NUMB and NOTCH, describing the current targets for therapeutic intervention and the potential use of NUMB profiling in patients with prostate cancer.

Autophagy is a beneficial adaptive response to cellular stress, but it can also benefit cancer cells, and can contribute to development of resistance to cancer treatments. The authors describe the complex roles of autophagy and the developments towards modulation of autophagy to improve the effectiveness of prostate cancer therapies.

Renal cell carcinoma (RCC) is the most lethal of the common urological cancers, and is increasing in incidence globally. Bhatt and Finelli present a Timeline of landmarks in four centuries of research and treatment of RCC, the most common renal cancer, discussing current therapies and future prospects.

Historically, the use of testosterone supplementation therapy (TST) for hypogonadism in men with prostate cancer has been limited by concerns that such treatment might cause progression of this androgen-dependent cancer; however, the contemporary literature indicates that TST in men with prostate cancer can be safe and, contrary to traditional thinking, that TST might actually reduce the risk of prostate cancer development. In this opinion piece, Larry Lipshultz and colleagues discuss the evidence supporting TST—in contrast with the lack of evidence against this approach—in hypogonodal men with prostate cancer.

Jannini et al. describe the evidence supporting the concept of the clitourethrovaginal (CUV) complex, and the overlap with the properties of the elusive G-spot. Consideration of the intricate anatomical relationships involved in female sexual arousal and orgasm could help to avoid damage to the CUV complex during surgery.